[Hiring] Rheumatologist-Physician Reviewer-Radiology @Evolent

Role Description

Evolent is currently seeking Rheumatologist Physicians to join our Radiology department. As an FMD, Radiology, you will be a key member of the utilization management team, offering a meaningful way to make a difference in patients' lives in a non-clinical environment. Enjoy better work-life balance on a team that values collaboration and continuous learning while providing better health outcomes.

Collaboration Opportunities:

• Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician's input is needed or required.

What You Will Be Doing:

• Serve as the Physician match reviewer in Imaging cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
• Discuss determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provide clinical rationale for standard and expedited appeals.
• Utilize medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU's policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
• Aid and act as a resource to Initial Clinical Reviewers.
• Ensure documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
• May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines, and/or system support.
• Participate in ongoing training per inter-rater reliability process.

Qualifications

• MD/DO/MBBS
• Minimum of five (5) years’ experience in the practice of Medicine, post residency, with active clinical practice within the last 2 years preferred.
• Current, unrestricted clinical license in home state medicine or required specialty.
• Obtaining and maintaining medical licenses in the state you reside, as well as any license required per business needs.
• Active Board Certification by an accredited organization.
• Strong clinical, management, communication, and organizational skills.
• Energetic and curious with a passion for quality and value in health care.
• Computer Proficiency.
• Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid.
• No history of a major disciplinary or legal action by a state medical board.

Requirements

• To ensure a secure hiring process, we have implemented several identity verification steps, including submission of a government-issued photo ID.
• Conduct identity verification during interviews; final interviews may require onsite attendance.
• All candidates must complete a comprehensive background check, in-person I-9 verification, and may be subject to drug screening prior to employment.
• The use of artificial intelligence tools during interviews is prohibited and monitored.
• Misrepresentation will result in immediate disqualification from consideration.

Benefits

• The expected base salary/wage range for this position is $95-109/hr.
• Evolent is proud to offer comprehensive benefits (including health insurance benefits) to qualifying employees.
• All compensation determinations are based on the skills and experience required for the position and commensurate with experience of selected individuals, which may vary above and below the stated amounts.